RubyGems - davinci_pas_test_kit - Versions diffs - 0.14.0 → 0.15.0 - Mend

davinci_pas_test_kit 0.14.0 → 0.15.0

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Files changed (461) hide show

data/config/presets/pas_server_v201_run_against_pas_client.json.erb ADDED Viewed

@@ -0,0 +1,76 @@
+{
+  "title": "Run Against the PAS Client Suite",
+  "id": "pas-server-v201-run-against-pas-client-tests",
+  "test_suite_id": "davinci_pas_server_suite_v201",
+  "inputs": [
+    {
+      "name": "server_endpoint",
+      "description": "Insert the FHIR server endpoint URL for PAS",
+      "title": "FHIR Server Endpoint URL",
+      "type": "text",
+      "value": "<%= Inferno::Application['base_url'] %>/custom/davinci_pas_client_suite_v201/demo_execution/fhir"
+    },
+    {
+      "name": "access_token",
+      "description": "An access token that the server under test will send to Inferno on notifications so that the request gets associated with this test session. The token must be provided as a `Bearer` token in the `Authorization` header of HTTP requests sent to Inferno.",
+      "title": "Notification Access Token",
+      "type": "text",
+      "value": "demo_execution"
+    },
+    {
+      "name": "subscription_resource",
+      "description": "A Subscription resource in JSON format that Inferno will send to the server under test so that it can demonstrate its ability to notify Inferno when pended prior authorization requests have been updated. The instance must be conformant to the R4/B Topic-Based Subscription profile. Inferno may modify the Subscription before submission, e.g., to point to Inferno's notification endpoint.",
+      "title": "Pended Prior Authorization Subscription",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\" : \"Subscription\",\n  \"meta\" : {\n    \"profile\" : [\"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-subscription\"]\n  },\n  \"status\" : \"requested\",\n  \"end\" : \"2020-12-31T12:00:00Z\",\n  \"reason\" : \"R4 Topic-Based Workflow Subscription for Patient Admission\",\n  \"criteria\" : \"http://hl7.org/fhir/us/davinci-pas/SubscriptionTopic/PASSubscriptionTopic\",\n  \"_criteria\" : {\n    \"extension\" : [{\n      \"url\" : \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-filter-criteria\",\n      \"valueString\" : \"Encounter.patient=Patient/123\"\n    }]\n  },\n  \"channel\" : {\n    \"extension\" : [{\n      \"url\" : \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-timeout\",\n      \"valueUnsignedInt\" : 60\n    },\n    {\n      \"url\" : \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-max-count\",\n      \"valuePositiveInt\" : 20\n    }],\n    \"type\" : \"rest-hook\",\n    \"header\": [\"Authorization: Bearer demo_execution\"],\n    \"endpoint\" : \"http://localhost:4567/custom/subscriptions_r5_backport_r4_server/subscription/channel/notification_listener\",\n    \"payload\" : \"application/fhir+json\",\n    \"_payload\" : {\n      \"extension\" : [{\n        \"url\" : \"http://hl7.org/fhir/uv/subscriptions-backport/StructureDefinition/backport-payload-content\",\n        \"valueCode\" : \"id-only\"\n      }]\n    }\n  }\n}"
+    },
+    {
+      "name": "approval_pa_submit_request_payload",
+      "description": "Insert Bundle to be sent for PAS Submit Request",
+      "optional": true,
+      "title": "PAS Submit Request Payload for Approval Response",
+      "type": "textarea",
+      "value": "{\"resourceType\":\"Bundle\",\"id\":\"ReferralAuthorizationBundleExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"]},\"identifier\":{\"system\":\"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\"value\":\"A12345\"},\"type\":\"collection\",\"timestamp\":\"2005-05-02T11:01:00+05:00\",\"entry\":[{\"fullUrl\":\"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\"resource\":{\"resourceType\":\"Claim\",\"id\":\"ReferralAuthorizationExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"]},\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1338\",\"code\":\"U\",\"display\":\"Urgent\"}]}},{\"url\":\"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\"valueReference\":{\"reference\":\"Encounter/SurgicalEncounterExample\"}}],\"identifier\":[{\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://www.usps.com/\",\"code\":\"MA\"}]}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\"valueString\":\"223412\"}],\"system\":\"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\"value\":\"111099\",\"assigner\":{\"identifier\":{\"system\":\"http://davinci-pas.org/USER_ASSIGNED\",\"value\":\"9012345678\"}}}],\"status\":\"active\",\"type\":{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/claim-type\",\"code\":\"professional\"}]},\"use\":\"preauthorization\",\"patient\":{\"reference\":\"Patient/SubscriberExample\"},\"created\":\"2005-05-02T11:01:00+05:00\",\"insurer\":{\"reference\":\"Organization/InsurerExample\"},\"provider\":{\"reference\":\"Organization/UMOExample\"},\"priority\":{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/processpriority\",\"code\":\"normal\"}]},\"careTeam\":[{\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\"valueBoolean\":true}],\"sequence\":1,\"provider\":{\"reference\":\"PractitionerRole/ReferralPractitionerRoleExample\"},\"qualification\":{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\"code\":\"604210\"}]},\"role\":{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\"code\":\"primary\"}]}}],\"diagnosis\":[{\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\"valueDate\":\"2021-05-10\"}],\"sequence\":1,\"diagnosisCodeableConcept\":{\"coding\":[{\"system\":\"http://hl7.org/fhir/sid/icd-10-cm\",\"code\":\"G89.4\"}]},\"type\":[{\"coding\":[{\"system\":\"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\"code\":\"patientreasonforvisit\"}]}]}],\"insurance\":[{\"sequence\":1,\"focal\":true,\"coverage\":{\"reference\":\"Coverage/InsuranceExample\"}}],\"item\":[{\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\"valueIdentifier\":{\"system\":\"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\"value\":\"1122334\"}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\"valueString\":\"1122445\"},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\"valueString\":\"9988311\"},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1525\",\"code\":\"SC\",\"display\":\"Specialty Care Review\"}]}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1322\",\"code\":\"I\",\"display\":\"Initial\"}]}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\"valueReference\":{\"reference\":\"ServiceRequest/ReferralRequestExample\"}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\"valueBoolean\":false},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1345\",\"code\":\"2\",\"display\":\"Newly Admitted\"}]}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1337\",\"code\":\"2\",\"display\":\"Intermediate Care Facility (ICF)\"}]}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\"valueDecimal\":100}],\"sequence\":1,\"careTeamSequence\":[1],\"diagnosisSequence\":[1],\"informationSequence\":[1],\"revenue\":{\"coding\":[{\"system\":\"https://www.nubc.org/revenue-code\",\"code\":\"0105\"}]},\"modifier\":[{\"coding\":[{\"system\":\"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\"code\":\"E0110\"}]}],\"servicedDate\":\"2016-08-09\",\"unitPrice\":{\"value\":1000,\"currency\":\"USD\"},\"quantity\":{\"value\":1},\"category\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1365\",\"code\":\"3\",\"display\":\"Consultation\"}]},\"productOrService\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1365\",\"code\":\"3\",\"display\":\"Consultation\"}]},\"locationCodeableConcept\":{\"coding\":[{\"system\":\"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\"code\":\"11\"}]}}],\"supportingInfo\":[{\"category\":{\"coding\":[{\"system\":\"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\"code\":\"additionalInformation\",\"display\":\"Additional Information\"}]},\"sequence\":1,\"valueReference\":{\"reference\":\"DocumentReference/episode-summary\"}},{\"category\":{\"coding\":[{\"system\":\"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\"code\":\"freeFormMessage\",\"display\":\"Free Form Message\"}]},\"sequence\":2,\"valueString\":\"1\"},{\"category\":{\"coding\":[{\"system\":\"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\"code\":\"patientEvent\",\"display\":\"Patient Event\"}]},\"sequence\":3,\"timingPeriod\":{\"start\":\"2021-09-01\",\"end\":\"2021-09-03\"}},{\"category\":{\"coding\":[{\"system\":\"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\"code\":\"admissionDates\",\"display\":\"Admission Dates\"}]},\"sequence\":4,\"timingPeriod\":{\"start\":\"2021-09-10\",\"end\":\"2021-09-12\"}},{\"category\":{\"coding\":[{\"system\":\"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\"code\":\"dischargeDates\",\"display\":\"Discharge Dates\"}]},\"sequence\":5,\"timingPeriod\":{\"start\":\"2021-09-13\",\"end\":\"2021-09-15\"}}],\"accident\":{\"date\":\"2016-03-09\",\"type\":{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/ex-claimaccidenttype\",\"code\":\"auto\",\"display\":\"Automobile\"}]}}}},{\"fullUrl\":\"http://davinci-pas.org/fhir/Organization/UMOExample\",\"resource\":{\"resourceType\":\"Organization\",\"id\":\"UMOExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"]},\"identifier\":[{\"system\":\"http://hl7.org/fhir/sid/us-npi\",\"value\":\"8189991234\"},{\"system\":\"http://terminology.hl7.org/NamingSystem/USEIN\",\"value\":\"8189948234\"}],\"active\":true,\"type\":[{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/98\",\"code\":\"X3\"}]}],\"name\":\"DR. JOE SMITH CORPORATION\",\"address\":[{\"line\":[\"111 1ST STREET\"],\"city\":\"SAN DIEGO\",\"state\":\"CA\",\"postalCode\":\"92101\",\"country\":\"US\"}],\"telecom\":[{\"system\":\"phone\",\"value\":\"4029993456\"}],\"contact\":[{\"telecom\":[{\"system\":\"other\",\"value\":\"http://hl7.org/fhir\"}],\"name\":{\"family\":\"WATSON\",\"given\":[\"SUSAN\"]}}]}},{\"fullUrl\":\"http://davinci-pas.org/fhir/Organization/InsurerExample\",\"resource\":{\"resourceType\":\"Organization\",\"id\":\"InsurerExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"]},\"identifier\":[{\"system\":\"http://hl7.org/fhir/sid/us-npi\",\"value\":\"789312\"},{\"system\":\"http://terminology.hl7.org/NamingSystem/USEIN\",\"value\":\"7239994834\"}],\"active\":true,\"type\":[{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/98\",\"code\":\"PR\"}]}],\"telecom\":[{\"system\":\"phone\",\"value\":\"3029993456\"}],\"name\":\"MARYLAND CAPITAL INSURANCE COMPANY\"}},{\"fullUrl\":\"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\"resource\":{\"resourceType\":\"Coverage\",\"id\":\"InsuranceExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"]},\"status\":\"active\",\"identifier\":[{\"system\":\"http://davinci-pas.org/MIN\",\"value\":\"1234567cov\"}],\"beneficiary\":{\"reference\":\"Patient/SubscriberExample\"},\"payor\":[{\"reference\":\"Organization/InsurerExample\"}],\"subscriber\":{\"reference\":\"Patient/SubscriberExample\"},\"subscriberId\":\"12345678901\",\"relationship\":{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\"code\":\"self\"},{\"system\":\"https://codesystem.x12.org/005010/1069\",\"code\":\"18\",\"display\":\"Self\"}]}}},{\"fullUrl\":\"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\"resource\":{\"resourceType\":\"Patient\",\"id\":\"SubscriberExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"]},\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/584\",\"code\":\"RU\"}]}},{\"extension\":[{\"url\":\"ombCategory\",\"valueCoding\":{\"system\":\"urn:oid:2.16.840.1.113883.6.238\",\"code\":\"2106-3\",\"display\":\"White\"}},{\"url\":\"text\",\"valueString\":\"Caucasian\"}],\"url\":\"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"},{\"extension\":[{\"url\":\"ombCategory\",\"valueCoding\":{\"system\":\"urn:oid:2.16.840.1.113883.6.238\",\"code\":\"2135-2\",\"display\":\"Hispanic or Latino\"}},{\"url\":\"text\",\"valueString\":\"Filipino\"}],\"url\":\"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"},{\"url\":\"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\"valueCode\":\"M\"}],\"identifier\":[{\"system\":\"http://davinci-pas.org/MIN\",\"value\":\"12345678901\"}],\"name\":[{\"family\":\"SMITH\",\"given\":[\"JOE\"],\"prefix\":[\"Mr\"],\"suffix\":[\"PharmD\"]}],\"gender\":\"male\",\"birthDate\":\"1987-02-20\",\"multipleBirthInteger\":1,\"communication\":[{\"language\":{\"coding\":[{\"system\":\"urn:ietf:bcp:47\",\"code\":\"nl-NL\",\"display\":\"Dutch (Netherlands)\"}]},\"preferred\":true}],\"telecom\":[{\"system\":\"phone\",\"value\":\"555-555-5555\",\"use\":\"home\"}],\"address\":[{\"line\":[\"49 Meadow St\"],\"city\":\"Mounds\",\"state\":\"OK\",\"district\":\"Meadow\",\"postalCode\":\"74047\",\"country\":\"US\",\"period\":{\"start\":\"2016-12-06\",\"end\":\"2020-07-22\"}}]}},{\"fullUrl\":\"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\"resource\":{\"resourceType\":\"ServiceRequest\",\"id\":\"ReferralRequestExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"]},\"status\":\"active\",\"intent\":\"order\",\"code\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1365\",\"code\":\"3\",\"display\":\"Consultation\"}]},\"occurrenceTiming\":{\"repeat\":{\"duration\":15,\"durationMax\":25,\"durationUnit\":\"min\",\"frequency\":1,\"frequencyMax\":4,\"period\":1,\"periodUnit\":\"d\"}},\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\"extension\":[{\"url\":\"coverage\",\"valueReference\":{\"reference\":\"Coverage/InsuranceExample\"}},{\"url\":\"covered\",\"valueCode\":\"covered\"},{\"url\":\"pa-needed\",\"valueCode\":\"auth-needed\"},{\"url\":\"date\",\"valueDate\":\"2021-09-10\"},{\"url\":\"coverage-assertion-id\",\"valueString\":\"1122445\"}]}],\"quantityQuantity\":{\"value\":1,\"unit\":\"visit\",\"system\":\"http://unitsofmeasure.org\",\"code\":\"1\"},\"subject\":{\"reference\":\"Patient/SubscriberExample\"}}},{\"fullUrl\":\"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\"resource\":{\"resourceType\":\"PractitionerRole\",\"id\":\"ReferralPractitionerRoleExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"]},\"practitioner\":{\"reference\":\"Practitioner/ReferralPractitionerExample\"},\"organization\":{\"reference\":\"Organization/UMOExample\"},\"location\":[{\"reference\":\"Location/ReferralLocationExample\"}]}},{\"fullUrl\":\"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\"resource\":{\"resourceType\":\"Practitioner\",\"id\":\"ReferralPractitionerExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"]},\"identifier\":[{\"system\":\"http://hl7.org/fhir/sid/us-npi\",\"value\":\"987654321\"}],\"name\":[{\"family\":\"WATSON\",\"given\":[\"SUSAN\"]}],\"telecom\":[{\"system\":\"phone\",\"value\":\"4029993456\"}],\"address\":[{\"line\":[\"111 1ST STREET\"],\"city\":\"SAN DIEGO\",\"state\":\"CA\",\"postalCode\":\"92101\",\"country\":\"US\"}]}},{\"fullUrl\":\"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\"resource\":{\"resourceType\":\"Location\",\"id\":\"ReferralLocationExample\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"]},\"name\":\"REFERRAL CLINIC\",\"address\":{\"line\":[\"111 1ST STREET\"],\"city\":\"SAN DIEGO\",\"state\":\"CA\",\"postalCode\":\"92101\",\"country\":\"US\"}}},{\"fullUrl\":\"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\"resource\":{\"resourceType\":\"DocumentReference\",\"id\":\"episode-summary\",\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"]},\"identifier\":[{\"system\":\"urn:ietf:rfc:3986\",\"value\":\"urn:oid:2.16.840.1.113883.19.5.99999.1\"}],\"status\":\"current\",\"type\":{\"coding\":[{\"system\":\"http://loinc.org\",\"code\":\"34133-9\",\"display\":\"Summary of episode note\"}],\"text\":\"CCD Document\"},\"category\":[{\"coding\":[{\"system\":\"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\"code\":\"clinical-note\",\"display\":\"Clinical Note\"}],\"text\":\"Clinical Note\"}],\"subject\":{\"reference\":\"Patient/SubscriberExample\"},\"date\":\"2016-03-09T15:29:46Z\",\"author\":[{\"reference\":\"Practitioner/ReferralPractitionerExample\"}],\"description\":\"Pulmonology clinic acute visit\",\"content\":[{\"attachment\":{\"contentType\":\"text/plain\",\"url\":\"/Binary/1-note\",\"title\":\"Uri where the data can be found: [base]/Binary/1-note\"},\"format\":{\"system\":\"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\"code\":\"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\"display\":\"Documents following C-CDA constraints using a structured body\"}}],\"context\":{\"period\":{\"start\":\"2004-12-23T08:00:00+11:00\",\"end\":\"2004-12-23T08:01:00+11:00\"}}}},{\"fullUrl\":\"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\"resource\":{\"resourceType\":\"Encounter\",\"id\":\"SurgicalEncounterExample\",\"identifier\":[{\"use\":\"temp\",\"system\":\"http://www.temp.com\",\"value\":\"Encounter_SubscriberExample_20130404\"}],\"status\":\"planned\",\"class\":{\"system\":\"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\"code\":\"AMB\",\"display\":\"ambulatory\"},\"type\":[{\"coding\":[{\"system\":\"http://snomed.info/sct\",\"code\":\"11429006\",\"display\":\"Consultation\"}]}],\"priority\":{\"coding\":[{\"system\":\"http://snomed.info/sct\",\"code\":\"17621005\",\"display\":\"Normal\"}]},\"subject\":{\"reference\":\"Patient/SubscriberExample\"},\"participant\":[{\"individual\":{\"reference\":\"Practitioner/ReferralPractitionerExample\"},\"type\":[{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\"code\":\"REF\"}]}],\"period\":{\"start\":\"2020-07-02\",\"end\":\"2020-07-09\"}}],\"reasonCode\":[{\"text\":\"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"}],\"period\":{\"start\":\"2020-07-02\",\"end\":\"2020-07-09\"},\"serviceProvider\":{\"reference\":\"Organization/UMOExample\"},\"hospitalization\":{\"admitSource\":{\"coding\":[{\"system\":\"https://www.nubc.org/CodeSystem/PointOfOrigin\",\"code\":\"5\"}]},\"dischargeDisposition\":{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\"code\":\"oth\"}]}},\"location\":[{\"location\":{\"reference\":\"Location/ReferralLocationExample\"}}],\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"]},\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1351\",\"code\":\"1\",\"display\":\"Admitted\"}]}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1345\",\"code\":\"2\",\"display\":\"Newly Admitted\"}]}}]}}]}"
+    },
+    {
+      "name": "denial_pa_submit_request_payload",
+      "description": "Insert Bundle to be sent for PAS Submit Request",
+      "optional": true,
+      "title": "PAS Submit Request Payload for Denial Response",
+      "type": "textarea",
+      "value": 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patient had fever peaks over the last couple of days. He is worried about these peaks.\"}],\"period\":{\"start\":\"2020-07-02\",\"end\":\"2020-07-09\"},\"serviceProvider\":{\"reference\":\"Organization/UMOExample\"},\"hospitalization\":{\"admitSource\":{\"coding\":[{\"system\":\"https://www.nubc.org/CodeSystem/PointOfOrigin\",\"code\":\"5\"}]},\"dischargeDisposition\":{\"coding\":[{\"system\":\"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\"code\":\"oth\"}]}},\"location\":[{\"location\":{\"reference\":\"Location/ReferralLocationExample\"}}],\"meta\":{\"profile\":[\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"]},\"extension\":[{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1351\",\"code\":\"1\",\"display\":\"Admitted\"}]}},{\"url\":\"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\"valueCodeableConcept\":{\"coding\":[{\"system\":\"https://codesystem.x12.org/005010/1345\",\"code\":\"2\",\"display\":\"Newly Admitted\"}]}}]}}]}"
+    },
+    {
+      "name": "pended_pa_inquire_request_payload",
+      "description": "Insert Bundle to be sent for PAS Inquire Request",
+      "optional": true,
+      "title": "PAS Inquire Request Payload",
+      "type": "textarea",
+      "value": "{\n  \"resourceType\": \"Bundle\",\n  \"id\": \"PASBundleInquiryExample\",\n  \"meta\": {\n    \"profile\": [\n      \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n    ]\n  },\n  \"identifier\": {\n    \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n    \"value\": \"A12345\"\n  },\n  \"type\": \"collection\",\n  \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n  \"entry\": [\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PASClaimInquiryExample\",\n      \"resource\": {\n        \"resourceType\": \"Claim\",\n        \"id\": \"PASClaimInquiryExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1338\",\n                  \"code\": \"U\",\n                  \"display\": \"Urgent\"\n                }\n              ]\n            }\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1322\",\n                  \"code\": \"I\",\n                  \"display\": \"Initial\"\n                }\n              ]\n            }\n          }\n        ],\n        \"identifier\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://www.usps.com/\",\n                      \"code\": \"MA\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                \"valueString\": \"223412\"\n              }\n            ],\n            \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n            \"value\": \"111099\",\n            \"assigner\": {\n              \"identifier\": {\n                \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                \"value\": \"9012345678\"\n              }\n            }\n          }\n        ],\n        \"status\": \"active\",\n        \"billablePeriod\": {\n          \"start\": \"2016-12-06\",\n          \"end\": \"2020-07-22\"\n        },\n        \"type\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n              \"code\": \"professional\"\n            }\n          ]\n        },\n        \"use\": \"preauthorization\",\n        \"patient\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"created\": \"2005-05-02T11:01:00+05:00\",\n        \"insurer\": {\n          \"reference\": \"Organization/InsurerExample\"\n        },\n        \"provider\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"priority\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n              \"code\": \"normal\"\n            }\n          ]\n        },\n        \"careTeam\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                \"valueBoolean\": true\n              }\n            ],\n            \"sequence\": 1,\n            \"provider\": {\n              \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n            },\n            \"qualification\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                  \"code\": \"604210\"\n                }\n              ]\n            },\n            \"role\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                  \"code\": \"primary\"\n                }\n              ]\n            }\n          }\n        ],\n        \"diagnosis\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                \"valueDate\": \"2021-05-10\"\n              }\n            ],\n            \"sequence\": 1,\n            \"diagnosisCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                  \"code\": \"G89.4\"\n                }\n              ]\n            },\n            \"type\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientreasonforvisit\"\n                  }\n                ]\n              }\n            ]\n          }\n        ],\n        \"insurance\": [\n          {\n            \"sequence\": 1,\n            \"focal\": true,\n            \"coverage\": {\n              \"reference\": \"Coverage/InsuranceExample\"\n            }\n          }\n        ],\n        \"item\": [\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                \"valueIdentifier\": {\n                  \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                  \"value\": \"1122334\"\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                \"valueString\": \"1122445\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                \"valueString\": \"9988311\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"HS\",\n                      \"display\": \"Health Services Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n                \"valueDate\": \"2022-09-10\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n                \"valueDate\": \"2021-09-10\"\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-reviewActionCode\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/306\",\n                      \"code\": \"A1\",\n                      \"display\": \"Certified in total\"\n                    }\n                  ]\n                }\n              }\n            ],\n            \"sequence\": 1,\n            \"careTeamSequence\": [\n              1\n            ],\n            \"diagnosisSequence\": [\n              1\n            ],\n            \"informationSequence\": [\n              1\n            ],\n            \"revenue\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/revenue-code\",\n                  \"code\": \"0105\"\n                }\n              ]\n            },\n            \"modifier\": [\n              {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"E0110\"\n                  }\n                ]\n              }\n            ],\n            \"servicedDate\": \"2016-08-09\",\n            \"quantity\": {\n              \"value\": 1\n            },\n            \"locationCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                  \"code\": \"11\"\n                }\n              ]\n            },\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                  \"code\": \"G0154\"\n                }\n              ]\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1525\",\n                      \"code\": \"HS\",\n                      \"display\": \"Health Services Review\"\n                    }\n                  ]\n                }\n              },\n              {\n                \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                \"valueCodeableConcept\": {\n                  \"coding\": [\n                    {\n                      \"system\": \"https://codesystem.x12.org/005010/1322\",\n                      \"code\": \"I\",\n                      \"display\": \"Initial\"\n                    }\n                  ]\n                }\n              }\n            ],\n            \"sequence\": 2,\n            \"productOrService\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                  \"code\": \"G0153\"\n                }\n              ]\n            },\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/1365\",\n                  \"code\": \"3\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            }\n          }\n        ],\n        \"accident\": {\n          \"date\": \"2016-03-09\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/ex-claimaccidenttype\",\n                \"code\": \"auto\",\n                \"display\": \"Automobile\"\n              }\n            ]\n          }\n        },\n        \"supportingInfo\": [\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"patientEvent\",\n                  \"display\": \"Patient Event\"\n                }\n              ]\n            },\n            \"sequence\": 3,\n            \"timingPeriod\": {\n              \"start\": \"2021-09-01\",\n              \"end\": \"2021-09-03\"\n            }\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"admissionDates\",\n                  \"display\": \"Admission Dates\"\n                }\n              ]\n            },\n            \"sequence\": 4,\n            \"timingPeriod\": {\n              \"start\": \"2021-09-10\",\n              \"end\": \"2021-09-12\"\n            }\n          },\n          {\n            \"category\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                  \"code\": \"dischargeDates\",\n                  \"display\": \"Discharge Dates\"\n                }\n              ]\n            },\n            \"sequence\": 5,\n            \"timingPeriod\": {\n              \"start\": \"2021-09-13\",\n              \"end\": \"2021-09-15\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n        \"id\": \"UMOExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"8189991234\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"8189948234\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"X3\"\n              }\n            ]\n          }\n        ],\n        \"name\": \"DR. JOE SMITH CORPORATION\",\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"contact\": [\n          {\n            \"telecom\": [\n              {\n                \"system\": \"other\",\n                \"value\": \"http://hl7.org/fhir\"\n              }\n            ],\n            \"name\": {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n      \"resource\": {\n        \"resourceType\": \"Organization\",\n        \"id\": \"InsurerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"789312\"\n          },\n          {\n            \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n            \"value\": \"7239994834\"\n          }\n        ],\n        \"active\": true,\n        \"type\": [\n          {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/98\",\n                \"code\": \"PR\"\n              }\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"3029993456\"\n          }\n        ],\n        \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n      \"resource\": {\n        \"resourceType\": \"Coverage\",\n        \"id\": \"InsuranceExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n          ]\n        },\n        \"status\": \"active\",\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"1234567cov\"\n          }\n        ],\n        \"beneficiary\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"payor\": [\n          {\n            \"reference\": \"Organization/InsurerExample\"\n          }\n        ],\n        \"subscriber\": {\n          \"reference\": \"Patient/SubscriberExample\"\n        },\n        \"subscriberId\": \"12345678901\",\n        \"relationship\": {\n          \"coding\": [\n            {\n              \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n              \"code\": \"self\"\n            },\n            {\n              \"system\": \"https://codesystem.x12.org/005010/1069\",\n              \"code\": \"18\",\n              \"display\": \"Self\"\n            }\n          ]\n        }\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n      \"resource\": {\n        \"resourceType\": \"Patient\",\n        \"id\": \"SubscriberExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n          ]\n        },\n        \"extension\": [\n          {\n            \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n            \"valueCodeableConcept\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/584\",\n                  \"code\": \"RU\"\n                }\n              ]\n            }\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2106-3\",\n                  \"display\": \"White\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Caucasian\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n          },\n          {\n            \"extension\": [\n              {\n                \"url\": \"ombCategory\",\n                \"valueCoding\": {\n                  \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                  \"code\": \"2135-2\",\n                  \"display\": \"Hispanic or Latino\"\n                }\n              },\n              {\n                \"url\": \"text\",\n                \"valueString\": \"Filipino\"\n              }\n            ],\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n          },\n          {\n            \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n            \"valueCode\": \"M\"\n          }\n        ],\n        \"identifier\": [\n          {\n            \"system\": \"http://davinci-pas.org/MIN\",\n            \"value\": \"12345678901\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"SMITH\",\n            \"given\": [\n              \"JOE\"\n            ],\n            \"prefix\": [\n              \"Mr\"\n            ],\n            \"suffix\": [\n              \"PharmD\"\n            ]\n          }\n        ],\n        \"gender\": \"male\",\n        \"birthDate\": \"1987-02-20\",\n        \"multipleBirthInteger\": 1,\n        \"communication\": [\n          {\n            \"language\": {\n              \"coding\": [\n                {\n                  \"system\": \"urn:ietf:bcp:47\",\n                  \"code\": \"nl-NL\",\n                  \"display\": \"Dutch (Netherlands)\"\n                }\n              ]\n            },\n            \"preferred\": true\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"555-555-5555\",\n            \"use\": \"home\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"49 Meadow St\"\n            ],\n            \"city\": \"Mounds\",\n            \"state\": \"OK\",\n            \"district\": \"Meadow\",\n            \"postalCode\": \"74047\",\n            \"country\": \"US\",\n            \"period\": {\n              \"start\": \"2016-12-06\",\n              \"end\": \"2020-07-22\"\n            }\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n      \"resource\": {\n        \"resourceType\": \"PractitionerRole\",\n        \"id\": \"ReferralPractitionerRoleExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n          ]\n        },\n        \"practitioner\": {\n          \"reference\": \"Practitioner/ReferralPractitionerExample\"\n        },\n        \"organization\": {\n          \"reference\": \"Organization/UMOExample\"\n        },\n        \"location\": [\n          {\n            \"reference\": \"Location/ReferralLocationExample\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n      \"resource\": {\n        \"resourceType\": \"Practitioner\",\n        \"id\": \"ReferralPractitionerExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n          ]\n        },\n        \"identifier\": [\n          {\n            \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n            \"value\": \"987654321\"\n          }\n        ],\n        \"name\": [\n          {\n            \"family\": \"WATSON\",\n            \"given\": [\n              \"SUSAN\"\n            ]\n          }\n        ],\n        \"telecom\": [\n          {\n            \"system\": \"phone\",\n            \"value\": \"4029993456\"\n          }\n        ],\n        \"address\": [\n          {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        ]\n      }\n    },\n    {\n      \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n      \"resource\": {\n        \"resourceType\": \"Location\",\n        \"id\": \"ReferralLocationExample\",\n        \"meta\": {\n          \"profile\": [\n            \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n          ]\n        },\n        \"name\": \"REFERRAL CLINIC\",\n        \"address\": {\n          \"line\": [\n            \"111 1ST STREET\"\n          ],\n          \"city\": \"SAN DIEGO\",\n          \"state\": \"CA\",\n          \"postalCode\": \"92101\",\n          \"country\": \"US\"\n        }\n      }\n    }\n  ]\n}"
+    },
+    {
+      "name": "must_support_pa_submit_request_payload",
+      "description": "Insert an additional request bundle or a list of bundles (e.g. [bundle_1, bundle_2])",
+      "optional": true,
+      "title": "Additional PAS Submit Request Payloads",
+      "type": "textarea",
+      "value": "[\n  {\n    \"resourceType\": \"Bundle\",\n    \"id\": \"DeviceAuthorizationBundleExample\",\n    \"meta\": {\n      \"profile\": [\n        \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n      ]\n    },\n    \"identifier\": {\n      \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n      \"value\": \"A12345\"\n    },\n    \"type\": \"collection\",\n    \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n    \"entry\": [\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n        \"resource\": {\n          \"resourceType\": \"Claim\",\n          \"id\": \"ReferralAuthorizationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1338\",\n                    \"code\": \"U\",\n                    \"display\": \"Urgent\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n              \"valueReference\": {\n                \"reference\": \"Encounter/SurgicalEncounterExample\"\n              }\n            }\n          ],\n          \"identifier\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://www.usps.com/\",\n                        \"code\": \"MA\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                  \"valueString\": \"223412\"\n                }\n              ],\n              \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n              \"value\": \"111099\",\n              \"assigner\": {\n                \"identifier\": {\n                  \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                  \"value\": \"9012345678\"\n                }\n              }\n            }\n          ],\n          \"status\": \"active\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n                \"code\": \"professional\"\n              }\n            ]\n          },\n          \"use\": \"preauthorization\",\n          \"patient\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"created\": \"2005-05-02T11:01:00+05:00\",\n          \"insurer\": {\n            \"reference\": \"Organization/InsurerExample\"\n          },\n          \"provider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n                \"code\": \"normal\"\n              }\n            ]\n          },\n          \"careTeam\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                  \"valueBoolean\": true\n                }\n              ],\n              \"sequence\": 1,\n              \"provider\": {\n                \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n              },\n              \"qualification\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                    \"code\": \"604210\"\n                  }\n                ]\n              },\n              \"role\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                    \"code\": \"primary\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                  \"valueBoolean\": false\n                }\n              ],\n              \"sequence\": 2,\n              \"provider\": {\n                \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n              },\n              \"qualification\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                    \"code\": \"604210\"\n                  }\n                ]\n              },\n              \"role\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                    \"code\": \"primary\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"diagnosis\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                  \"valueDate\": \"2021-05-10\"\n                }\n              ],\n              \"sequence\": 1,\n              \"diagnosisCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                    \"code\": \"G89.4\"\n                  }\n                ]\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                      \"code\": \"patientreasonforvisit\"\n                    }\n                  ]\n                }\n              ]\n            }\n          ],\n          \"insurance\": [\n            {\n              \"sequence\": 1,\n              \"focal\": true,\n              \"coverage\": {\n                \"reference\": \"Coverage/InsuranceExample\"\n              }\n            }\n          ],\n          \"item\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                  \"valueIdentifier\": {\n                    \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                    \"value\": \"1122334\"\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                  \"valueString\": \"1122445\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                  \"valueString\": \"9988311\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1525\",\n                        \"code\": \"SC\",\n                        \"display\": \"Specialty Care Review\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1322\",\n                        \"code\": \"I\",\n                        \"display\": \"Initial\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                  \"valueReference\": {\n                    \"reference\": \"DeviceRequest/DeviceRequestExample\"\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                  \"valueBoolean\": false\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1345\",\n                        \"code\": \"2\",\n                        \"display\": \"Newly Admitted\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1337\",\n                        \"code\": \"2\",\n                        \"display\": \"Intermediate Care Facility (ICF)\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                  \"valueDecimal\": 100\n                }\n              ],\n              \"sequence\": 1,\n              \"careTeamSequence\": [\n                1\n              ],\n              \"diagnosisSequence\": [\n                1\n              ],\n              \"informationSequence\": [\n                1\n              ],\n              \"revenue\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.nubc.org/revenue-code\",\n                    \"code\": \"0105\"\n                  }\n                ]\n              },\n              \"modifier\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                      \"code\": \"E0110\"\n                    }\n                  ]\n                }\n              ],\n              \"servicedDate\": \"2016-08-09\",\n              \"unitPrice\": {\n                \"value\": 1000,\n                \"currency\": \"USD\"\n              },\n              \"quantity\": {\n                \"value\": 1\n              },\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n                    \"display\": \"Consultation\"\n                  }\n                ]\n              },\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n                    \"display\": \"Consultation\"\n                  }\n                ]\n              },\n              \"locationCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                    \"code\": \"11\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"supportingInfo\": [\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"additionalInformation\",\n                    \"display\": \"Additional Information\"\n                  }\n                ]\n              },\n              \"sequence\": 1,\n              \"valueReference\": {\n                \"reference\": \"DocumentReference/episode-summary\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"freeFormMessage\",\n                    \"display\": \"Free Form Message\"\n                  }\n                ]\n              },\n              \"sequence\": 2,\n              \"valueString\": \"1\"\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientEvent\",\n                    \"display\": \"Patient Event\"\n                  }\n                ]\n              },\n              \"sequence\": 3,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-01\",\n                \"end\": \"2021-09-03\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"admissionDates\",\n                    \"display\": \"Admission Dates\"\n                  }\n                ]\n              },\n              \"sequence\": 4,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-10\",\n                \"end\": \"2021-09-12\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"dischargeDates\",\n                    \"display\": \"Discharge Dates\"\n                  }\n                ]\n              },\n              \"sequence\": 5,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-13\",\n                \"end\": \"2021-09-15\"\n              }\n            }\n          ],\n          \"accident\": {\n            \"date\": \"2016-03-09\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-claimaccidenttype\",\n                  \"code\": \"auto\",\n                  \"display\": \"Automobile\"\n                }\n              ]\n            }\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n        \"resource\": {\n          \"resourceType\": \"Organization\",\n          \"id\": \"UMOExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"8189991234\"\n            },\n            {\n              \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n              \"value\": \"8189948234\"\n            }\n          ],\n          \"active\": true,\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"X3\"\n                }\n              ]\n            }\n          ],\n          \"name\": \"DR. JOE SMITH CORPORATION\",\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"contact\": [\n            {\n              \"telecom\": [\n                {\n                  \"system\": \"other\",\n                  \"value\": \"http://hl7.org/fhir\"\n                }\n              ],\n              \"name\": {\n                \"family\": \"WATSON\",\n                \"given\": [\n                  \"SUSAN\"\n                ]\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n        \"resource\": {\n          \"resourceType\": \"Organization\",\n          \"id\": \"InsurerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"789312\"\n            },\n            {\n              \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n              \"value\": \"7239994834\"\n            }\n          ],\n          \"active\": true,\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"PR\"\n                }\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"3029993456\"\n            }\n          ],\n          \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n        \"resource\": {\n          \"resourceType\": \"Coverage\",\n          \"id\": \"InsuranceExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n            ]\n          },\n          \"status\": \"active\",\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"1234567cov\"\n            }\n          ],\n          \"beneficiary\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"payor\": [\n            {\n              \"reference\": \"Organization/InsurerExample\"\n            }\n          ],\n          \"subscriber\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"subscriberId\": \"12345678901\",\n          \"relationship\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n                \"code\": \"self\"\n              },\n              {\n                \"system\": \"https://codesystem.x12.org/005010/1069\",\n                \"code\": \"18\",\n                \"display\": \"Self\"\n              }\n            ]\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n        \"resource\": {\n          \"resourceType\": \"Patient\",\n          \"id\": \"SubscriberExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/584\",\n                    \"code\": \"RU\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2106-3\",\n                    \"display\": \"White\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Caucasian\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2135-2\",\n                    \"display\": \"Hispanic or Latino\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Filipino\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n              \"valueCode\": \"M\"\n            }\n          ],\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"12345678901\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"SMITH\",\n              \"given\": [\n                \"JOE\"\n              ],\n              \"prefix\": [\n                \"Mr\"\n              ],\n              \"suffix\": [\n                \"PharmD\"\n              ]\n            }\n          ],\n          \"gender\": \"male\",\n          \"birthDate\": \"1987-02-20\",\n          \"multipleBirthInteger\": 1,\n          \"communication\": [\n            {\n              \"language\": {\n                \"coding\": [\n                  {\n                    \"system\": \"urn:ietf:bcp:47\",\n                    \"code\": \"nl-NL\",\n                    \"display\": \"Dutch (Netherlands)\"\n                  }\n                ]\n              },\n              \"preferred\": true\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"555-555-5555\",\n              \"use\": \"home\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"49 Meadow St\"\n              ],\n              \"city\": \"Mounds\",\n              \"state\": \"OK\",\n              \"district\": \"Meadow\",\n              \"postalCode\": \"74047\",\n              \"country\": \"US\",\n              \"period\": {\n                \"start\": \"2016-12-06\",\n                \"end\": \"2020-07-22\"\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/DeviceRequest/DeviceRequestExample\",\n        \"resource\": {\n          \"resourceType\": \"DeviceRequest\",\n          \"id\": \"DeviceRequestExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-devicerequest\"\n            ]\n          },\n          \"status\": \"active\",\n          \"intent\": \"order\",\n          \"codeCodeableConcept\": {\n            \"coding\": [\n              {\n                \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                \"code\": \"E1223\"\n              }\n            ]\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n              \"extension\": [\n                {\n                  \"url\": \"coverage\",\n                  \"valueReference\": {\n                    \"reference\": \"Coverage/InsuranceExample\"\n                  }\n                },\n                {\n                  \"url\": \"covered\",\n                  \"valueCode\": \"covered\"\n                },\n                {\n                  \"url\": \"pa-needed\",\n                  \"valueCode\": \"auth-needed\"\n                },\n                {\n                  \"url\": \"date\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"coverage-assertion-id\",\n                  \"valueString\": \"1122445\"\n                }\n              ]\n            }\n          ],\n          \"authoredOn\": \"2005-06-02\",\n          \"occurrenceTiming\": {\n            \"repeat\": {\n              \"duration\": 15,\n              \"durationMax\": 25,\n              \"durationUnit\": \"min\",\n              \"frequency\": 1,\n              \"frequencyMax\": 4,\n              \"period\": 1,\n              \"periodUnit\": \"d\"\n            }\n          },\n          \"requester\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n        \"resource\": {\n          \"resourceType\": \"PractitionerRole\",\n          \"id\": \"ReferralPractitionerRoleExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n            ]\n          },\n          \"practitioner\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          },\n          \"organization\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"location\": [\n            {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n        \"resource\": {\n          \"resourceType\": \"Practitioner\",\n          \"id\": \"ReferralPractitionerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"987654321\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n        \"resource\": {\n          \"resourceType\": \"Location\",\n          \"id\": \"ReferralLocationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n            ]\n          },\n          \"name\": \"REFERRAL CLINIC\",\n          \"address\": {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n        \"resource\": {\n          \"resourceType\": \"DocumentReference\",\n          \"id\": \"episode-summary\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"urn:ietf:rfc:3986\",\n              \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n            }\n          ],\n          \"status\": \"current\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://loinc.org\",\n                \"code\": \"34133-9\",\n                \"display\": \"Summary of episode note\"\n              }\n            ],\n            \"text\": \"CCD Document\"\n          },\n          \"category\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                  \"code\": \"clinical-note\",\n                  \"display\": \"Clinical Note\"\n                }\n              ],\n              \"text\": \"Clinical Note\"\n            }\n          ],\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"date\": 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],\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"17621005\",\n                \"display\": \"Normal\"\n              }\n            ]\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"participant\": [\n            {\n              \"individual\": {\n                \"reference\": \"Practitioner/ReferralPractitionerExample\"\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                      \"code\": \"REF\"\n                    }\n                  ]\n                }\n              ],\n              \"period\": {\n                \"start\": \"2020-07-02\",\n                \"end\": \"2020-07-09\"\n              }\n            }\n          ],\n          \"reasonCode\": [\n            {\n              \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n            }\n          ],\n          \"period\": {\n            \"start\": \"2020-07-02\",\n            \"end\": \"2020-07-09\"\n          },\n          \"serviceProvider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"hospitalization\": {\n            \"admitSource\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                  \"code\": \"5\"\n                }\n              ]\n            },\n            \"dischargeDisposition\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                  \"code\": \"oth\"\n                }\n              ]\n            }\n          },\n          \"location\": [\n            {\n              \"location\": {\n                \"reference\": \"Location/ReferralLocationExample\"\n              }\n            }\n          ],\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1351\",\n                    \"code\": \"1\",\n                    \"display\": \"Admitted\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1345\",\n                    \"code\": \"2\",\n                    \"display\": \"Newly Admitted\"\n                  }\n                ]\n              }\n            }\n          ]\n        }\n      }\n    ]\n  },\n  {\n    \"resourceType\": \"Bundle\",\n    \"id\": \"ReferralAuthorizationBundleExample\",\n    \"meta\": {\n      \"profile\": [\n        \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n      ]\n    },\n    \"identifier\": {\n      \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n      \"value\": \"A12345\"\n    },\n    \"type\": \"collection\",\n    \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n    \"entry\": [\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/ReferralAuthorizationExample\",\n        \"resource\": {\n          \"resourceType\": \"Claim\",\n          \"id\": \"ReferralAuthorizationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1338\",\n                    \"code\": \"U\",\n                    \"display\": \"Urgent\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/5.0/StructureDefinition/extension-Claim.encounter\",\n              \"valueReference\": {\n                \"reference\": \"Encounter/SurgicalEncounterExample\"\n              }\n            }\n          ],\n          \"identifier\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://www.usps.com/\",\n                        \"code\": \"MA\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                  \"valueString\": \"223412\"\n                }\n              ],\n              \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n              \"value\": \"111099\",\n              \"assigner\": {\n                \"identifier\": {\n                  \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                  \"value\": \"9012345678\"\n                }\n              }\n            }\n          ],\n          \"status\": \"active\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n                \"code\": \"professional\"\n              }\n            ]\n          },\n          \"use\": \"preauthorization\",\n          \"patient\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"created\": \"2005-05-02T11:01:00+05:00\",\n          \"insurer\": {\n            \"reference\": \"Organization/InsurerExample\"\n          },\n          \"provider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n                \"code\": \"normal\"\n              }\n            ]\n          },\n          \"careTeam\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                  \"valueBoolean\": true\n                }\n              ],\n              \"sequence\": 1,\n              \"provider\": {\n                \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n              },\n              \"qualification\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                    \"code\": \"604210\"\n                  }\n                ]\n              },\n              \"role\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                    \"code\": \"primary\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                  \"valueBoolean\": false\n                }\n              ],\n              \"sequence\": 2,\n              \"provider\": {\n                \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n              },\n              \"qualification\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                    \"code\": \"604210\"\n                  }\n                ]\n              },\n              \"role\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                    \"code\": \"primary\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"diagnosis\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                  \"valueDate\": \"2021-05-10\"\n                }\n              ],\n              \"sequence\": 1,\n              \"diagnosisCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                    \"code\": \"G89.4\"\n                  }\n                ]\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                      \"code\": \"patientreasonforvisit\"\n                    }\n                  ]\n                }\n              ]\n            }\n          ],\n          \"insurance\": [\n            {\n              \"sequence\": 1,\n              \"focal\": true,\n              \"coverage\": {\n                \"reference\": \"Coverage/InsuranceExample\"\n              }\n            }\n          ],\n          \"item\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                  \"valueIdentifier\": {\n                    \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                    \"value\": \"1122334\"\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                  \"valueString\": \"1122445\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                  \"valueString\": \"9988311\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1525\",\n                        \"code\": \"SC\",\n                        \"display\": \"Specialty Care Review\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1322\",\n                        \"code\": \"I\",\n                        \"display\": \"Initial\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-requestedService\",\n                  \"valueReference\": {\n                    \"reference\": \"ServiceRequest/ReferralRequestExample\"\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-epsdtIndicator\",\n                  \"valueBoolean\": false\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1345\",\n                        \"code\": \"2\",\n                        \"display\": \"Newly Admitted\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeLevelOfCare\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1337\",\n                        \"code\": \"2\",\n                        \"display\": \"Intermediate Care Facility (ICF)\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-revenueUnitRateLimit\",\n                  \"valueDecimal\": 100\n                }\n              ],\n              \"sequence\": 1,\n              \"careTeamSequence\": [\n                1\n              ],\n              \"diagnosisSequence\": [\n                1\n              ],\n              \"informationSequence\": [\n                1\n              ],\n              \"revenue\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.nubc.org/revenue-code\",\n                    \"code\": \"0105\"\n                  }\n                ]\n              },\n              \"modifier\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                      \"code\": \"E0110\"\n                    }\n                  ]\n                }\n              ],\n              \"servicedDate\": \"2016-08-09\",\n              \"unitPrice\": {\n                \"value\": 1000,\n                \"currency\": \"USD\"\n              },\n              \"quantity\": {\n                \"value\": 1\n              },\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n                    \"display\": \"Consultation\"\n                  }\n                ]\n              },\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n                    \"display\": \"Consultation\"\n                  }\n                ]\n              },\n              \"locationCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                    \"code\": \"11\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"supportingInfo\": [\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"additionalInformation\",\n                    \"display\": \"Additional Information\"\n                  }\n                ]\n              },\n              \"sequence\": 1,\n              \"valueReference\": {\n                \"reference\": \"DocumentReference/episode-summary\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"freeFormMessage\",\n                    \"display\": \"Free Form Message\"\n                  }\n                ]\n              },\n              \"sequence\": 2,\n              \"valueString\": \"1\"\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"patientEvent\",\n                    \"display\": \"Patient Event\"\n                  }\n                ]\n              },\n              \"sequence\": 3,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-01\",\n                \"end\": \"2021-09-03\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"admissionDates\",\n                    \"display\": \"Admission Dates\"\n                  }\n                ]\n              },\n              \"sequence\": 4,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-10\",\n                \"end\": \"2021-09-12\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"dischargeDates\",\n                    \"display\": \"Discharge Dates\"\n                  }\n                ]\n              },\n              \"sequence\": 5,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-13\",\n                \"end\": \"2021-09-15\"\n              }\n            }\n          ],\n          \"accident\": {\n            \"date\": \"2016-03-09\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-claimaccidenttype\",\n                  \"code\": \"auto\",\n                  \"display\": \"Automobile\"\n                }\n              ]\n            }\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n        \"resource\": {\n          \"resourceType\": \"Organization\",\n          \"id\": \"UMOExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"8189991234\"\n            },\n            {\n              \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n              \"value\": \"8189948234\"\n            }\n          ],\n          \"active\": true,\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"X3\"\n                }\n              ]\n            }\n          ],\n          \"name\": \"DR. JOE SMITH CORPORATION\",\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"contact\": [\n            {\n              \"telecom\": [\n                {\n                  \"system\": \"other\",\n                  \"value\": \"http://hl7.org/fhir\"\n                }\n              ],\n              \"name\": {\n                \"family\": \"WATSON\",\n                \"given\": [\n                  \"SUSAN\"\n                ]\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n        \"resource\": {\n          \"resourceType\": \"Organization\",\n          \"id\": \"InsurerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"789312\"\n            },\n            {\n              \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n              \"value\": \"7239994834\"\n            }\n          ],\n          \"active\": true,\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"PR\"\n                }\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"3029993456\"\n            }\n          ],\n          \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n        \"resource\": {\n          \"resourceType\": \"Coverage\",\n          \"id\": \"InsuranceExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n            ]\n          },\n          \"status\": \"active\",\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"1234567cov\"\n            }\n          ],\n          \"beneficiary\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"payor\": [\n            {\n              \"reference\": \"Organization/InsurerExample\"\n            }\n          ],\n          \"subscriber\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"subscriberId\": \"12345678901\",\n          \"relationship\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n                \"code\": \"self\"\n              },\n              {\n                \"system\": \"https://codesystem.x12.org/005010/1069\",\n                \"code\": \"18\",\n                \"display\": \"Self\"\n              }\n            ]\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n        \"resource\": {\n          \"resourceType\": \"Patient\",\n          \"id\": \"SubscriberExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/584\",\n                    \"code\": \"RU\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2106-3\",\n                    \"display\": \"White\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Caucasian\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2135-2\",\n                    \"display\": \"Hispanic or Latino\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Filipino\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n              \"valueCode\": \"M\"\n            }\n          ],\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"12345678901\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"SMITH\",\n              \"given\": [\n                \"JOE\"\n              ],\n              \"prefix\": [\n                \"Mr\"\n              ],\n              \"suffix\": [\n                \"PharmD\"\n              ]\n            }\n          ],\n          \"gender\": \"male\",\n          \"birthDate\": \"1987-02-20\",\n          \"multipleBirthInteger\": 1,\n          \"communication\": [\n            {\n              \"language\": {\n                \"coding\": [\n                  {\n                    \"system\": \"urn:ietf:bcp:47\",\n                    \"code\": \"nl-NL\",\n                    \"display\": \"Dutch (Netherlands)\"\n                  }\n                ]\n              },\n              \"preferred\": true\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"555-555-5555\",\n              \"use\": \"home\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"49 Meadow St\"\n              ],\n              \"city\": \"Mounds\",\n              \"state\": \"OK\",\n              \"district\": \"Meadow\",\n              \"postalCode\": \"74047\",\n              \"country\": \"US\",\n              \"period\": {\n                \"start\": \"2016-12-06\",\n                \"end\": \"2020-07-22\"\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/ServiceRequest/ReferralRequestExample\",\n        \"resource\": {\n          \"resourceType\": \"ServiceRequest\",\n          \"id\": \"ReferralRequestExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-servicerequest\"\n            ]\n          },\n          \"status\": \"active\",\n          \"intent\": \"order\",\n          \"code\": {\n            \"coding\": [\n              {\n                \"system\": \"https://codesystem.x12.org/005010/1365\",\n                \"code\": \"3\",\n                \"display\": \"Consultation\"\n              }\n            ]\n          },\n          \"occurrenceTiming\": {\n            \"repeat\": {\n              \"duration\": 15,\n              \"durationMax\": 25,\n              \"durationUnit\": \"min\",\n              \"frequency\": 1,\n              \"frequencyMax\": 4,\n              \"period\": 1,\n              \"periodUnit\": \"d\"\n            }\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-productOrServiceCodeEnd\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"G0155\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-crd/StructureDefinition/ext-coverage-information\",\n              \"extension\": [\n                {\n                  \"url\": \"coverage\",\n                  \"valueReference\": {\n                    \"reference\": \"Coverage/InsuranceExample\"\n                  }\n                },\n                {\n                  \"url\": \"covered\",\n                  \"valueCode\": \"covered\"\n                },\n                {\n                  \"url\": \"pa-needed\",\n                  \"valueCode\": \"auth-needed\"\n                },\n                {\n                  \"url\": \"date\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"coverage-assertion-id\",\n                  \"valueString\": \"1122445\"\n                }\n              ]\n            }\n          ],\n          \"quantityQuantity\": {\n            \"value\": 1,\n            \"unit\": \"visit\",\n            \"system\": \"http://unitsofmeasure.org\",\n            \"code\": \"1\"\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n        \"resource\": {\n          \"resourceType\": \"PractitionerRole\",\n          \"id\": \"ReferralPractitionerRoleExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n            ]\n          },\n          \"practitioner\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          },\n          \"organization\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"location\": [\n            {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n        \"resource\": {\n          \"resourceType\": \"Practitioner\",\n          \"id\": \"ReferralPractitionerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"987654321\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n        \"resource\": {\n          \"resourceType\": \"Location\",\n          \"id\": \"ReferralLocationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n            ]\n          },\n          \"name\": \"REFERRAL CLINIC\",\n          \"address\": {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/DocumentReference/episode-summary\",\n        \"resource\": {\n          \"resourceType\": \"DocumentReference\",\n          \"id\": \"episode-summary\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-documentreference\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"urn:ietf:rfc:3986\",\n              \"value\": \"urn:oid:2.16.840.1.113883.19.5.99999.1\"\n            }\n          ],\n          \"status\": \"current\",\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://loinc.org\",\n                \"code\": \"34133-9\",\n                \"display\": \"Summary of episode note\"\n              }\n            ],\n            \"text\": \"CCD Document\"\n          },\n          \"category\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://hl7.org/fhir/us/core/CodeSystem/us-core-documentreference-category\",\n                  \"code\": \"clinical-note\",\n                  \"display\": \"Clinical Note\"\n                }\n              ],\n              \"text\": \"Clinical Note\"\n            }\n          ],\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"date\": \"2016-03-09T15:29:46Z\",\n          \"author\": [\n            {\n              \"reference\": \"Practitioner/ReferralPractitionerExample\"\n            }\n          ],\n          \"description\": \"Pulmonology clinic acute visit\",\n          \"content\": [\n            {\n              \"attachment\": {\n                \"contentType\": \"text/plain\",\n                \"url\": \"/Binary/1-note\",\n                \"title\": \"Uri where the data can be found: [base]/Binary/1-note\"\n              },\n              \"format\": {\n                \"system\": \"urn:oid:1.3.6.1.4.1.19376.1.2.3\",\n                \"code\": \"urn:hl7-org:sdwg:ccda-structuredBody:2.1\",\n                \"display\": \"Documents following C-CDA constraints using a structured body\"\n              }\n            }\n          ],\n          \"context\": {\n            \"period\": {\n              \"start\": \"2004-12-23T08:00:00+11:00\",\n              \"end\": \"2004-12-23T08:01:00+11:00\"\n            }\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Encounter/SurgicalEncounterExample\",\n        \"resource\": {\n          \"resourceType\": \"Encounter\",\n          \"id\": \"SurgicalEncounterExample\",\n          \"identifier\": [\n            {\n              \"use\": \"temp\",\n              \"system\": \"http://www.temp.com\",\n              \"value\": \"Encounter_SubscriberExample_20130404\"\n            }\n          ],\n          \"status\": \"planned\",\n          \"class\": {\n            \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ActCode\",\n            \"code\": \"AMB\",\n            \"display\": \"ambulatory\"\n          },\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"http://snomed.info/sct\",\n                  \"code\": \"11429006\",\n                  \"display\": \"Consultation\"\n                }\n              ]\n            }\n          ],\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://snomed.info/sct\",\n                \"code\": \"17621005\",\n                \"display\": \"Normal\"\n              }\n            ]\n          },\n          \"subject\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"participant\": [\n            {\n              \"individual\": {\n                \"reference\": \"Practitioner/ReferralPractitionerExample\"\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://terminology.hl7.org/CodeSystem/v3-ParticipationType\",\n                      \"code\": \"REF\"\n                    }\n                  ]\n                }\n              ],\n              \"period\": {\n                \"start\": \"2020-07-02\",\n                \"end\": \"2020-07-09\"\n              }\n            }\n          ],\n          \"reasonCode\": [\n            {\n              \"text\": \"The patient had fever peaks over the last couple of days. He is worried about these peaks.\"\n            }\n          ],\n          \"period\": {\n            \"start\": \"2020-07-02\",\n            \"end\": \"2020-07-09\"\n          },\n          \"serviceProvider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"hospitalization\": {\n            \"admitSource\": {\n              \"coding\": [\n                {\n                  \"system\": \"https://www.nubc.org/CodeSystem/PointOfOrigin\",\n                  \"code\": \"5\"\n                }\n              ]\n            },\n            \"dischargeDisposition\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/discharge-disposition\",\n                  \"code\": \"oth\"\n                }\n              ]\n            }\n          },\n          \"location\": [\n            {\n              \"location\": {\n                \"reference\": \"Location/ReferralLocationExample\"\n              }\n            }\n          ],\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-encounter\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-patientStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1351\",\n                    \"code\": \"1\",\n                    \"display\": \"Admitted\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-nursingHomeResidentialStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1345\",\n                    \"code\": \"2\",\n                    \"display\": \"Newly Admitted\"\n                  }\n                ]\n              }\n            }\n          ]\n        }\n      }\n    ]\n  }\n]"
+    },
+    {
+      "name": "must_support_pa_inquire_request_payload",
+      "description": "Insert an additional request bundle or a list of bundles (e.g. [bundle_1, bundle_2])",
+      "optional": true,
+      "title": "Additional PAS Inquire Request Payloads",
+      "type": "textarea",
+      "value": "[\n  {\n    \"resourceType\": \"Bundle\",\n    \"id\": \"PASBundleInquiryExample\",\n    \"meta\": {\n      \"profile\": [\n        \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-pas-request-bundle\"\n      ]\n    },\n    \"identifier\": {\n      \"system\": \"http://davinci-pas.org/SUBMITTER_TRANSACTION_IDENTIFIER\",\n      \"value\": \"A12345\"\n    },\n    \"type\": \"collection\",\n    \"timestamp\": \"2005-05-02T11:01:00+05:00\",\n    \"entry\": [\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Claim/PASClaimInquiryExample\",\n        \"resource\": {\n          \"resourceType\": \"Claim\",\n          \"id\": \"PASClaimInquiryExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-claim\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-levelOfServiceCode\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1338\",\n                    \"code\": \"U\",\n                    \"display\": \"Urgent\"\n                  }\n                ]\n              }\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1322\",\n                    \"code\": \"I\",\n                    \"display\": \"Initial\"\n                  }\n                ]\n              }\n            }\n          ],\n          \"identifier\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierJurisdiction\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://www.usps.com/\",\n                        \"code\": \"MA\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-identifierSubDepartment\",\n                  \"valueString\": \"223412\"\n                }\n              ],\n              \"system\": \"http://davinci-pas.org/PATIENT_EVENT_TRACE_NUMBER\",\n              \"value\": \"111099\",\n              \"assigner\": {\n                \"identifier\": {\n                  \"system\": \"http://davinci-pas.org/USER_ASSIGNED\",\n                  \"value\": \"9012345678\"\n                }\n              }\n            }\n          ],\n          \"status\": \"active\",\n          \"billablePeriod\": {\n            \"start\": \"2016-12-06\",\n            \"end\": \"2020-07-22\"\n          },\n          \"type\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/claim-type\",\n                \"code\": \"professional\"\n              }\n            ]\n          },\n          \"use\": \"preauthorization\",\n          \"patient\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"created\": \"2005-05-02T11:01:00+05:00\",\n          \"insurer\": {\n            \"reference\": \"Organization/InsurerExample\"\n          },\n          \"provider\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"priority\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/processpriority\",\n                \"code\": \"normal\"\n              }\n            ]\n          },\n          \"careTeam\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-careTeamClaimScope\",\n                  \"valueBoolean\": true\n                }\n              ],\n              \"sequence\": 1,\n              \"provider\": {\n                \"reference\": \"PractitionerRole/ReferralPractitionerRoleExample\"\n              },\n              \"qualification\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/ex-providerqualification\",\n                    \"code\": \"604210\"\n                  }\n                ]\n              },\n              \"role\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://terminology.hl7.org/CodeSystem/claimcareteamrole\",\n                    \"code\": \"primary\"\n         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               }\n                ]\n              }\n            }\n          ],\n          \"diagnosis\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-diagnosisRecordedDate\",\n                  \"valueDate\": \"2021-05-10\"\n                }\n              ],\n              \"sequence\": 1,\n              \"diagnosisCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/sid/icd-10-cm\",\n                    \"code\": \"G89.4\"\n                  }\n                ]\n              },\n              \"type\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                      \"code\": \"patientreasonforvisit\"\n                    }\n                  ]\n                }\n              ]\n            }\n          ],\n          \"insurance\": [\n            {\n              \"sequence\": 1,\n              \"focal\": true,\n              \"coverage\": {\n                \"reference\": \"Coverage/InsuranceExample\"\n              }\n            }\n          ],\n          \"item\": [\n            {\n              \"extension\": [\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemTraceNumber\",\n                  \"valueIdentifier\": {\n                    \"system\": \"http://davinci-pas.org/ITEM_TRACE_NUMBER\",\n                    \"value\": \"1122334\"\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-authorizationNumber\",\n                  \"valueString\": \"1122445\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-administrationReferenceNumber\",\n                  \"valueString\": \"9988311\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-serviceItemRequestType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1525\",\n                        \"code\": \"HS\",\n                        \"display\": \"Health Services Review\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1322\",\n                        \"code\": \"I\",\n                        \"display\": \"Initial\"\n                      }\n                    ]\n                  }\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationIssueDate\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationExpirationDate\",\n                  \"valueDate\": \"2022-09-10\"\n                },\n                {\n                  \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-itemCertificationEffectiveDate\",\n                  \"valueDate\": \"2021-09-10\"\n                },\n                {\n                  \"url\": 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},\n              \"modifier\": [\n                {\n                  \"coding\": [\n                    {\n                      \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                      \"code\": \"E0110\"\n                    }\n                  ]\n                }\n              ],\n              \"servicedDate\": \"2016-08-09\",\n              \"quantity\": {\n                \"value\": 1\n              },\n              \"locationCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set\",\n                    \"code\": \"11\"\n                  }\n                ]\n              },\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": 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\"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-certificationType\",\n                  \"valueCodeableConcept\": {\n                    \"coding\": [\n                      {\n                        \"system\": \"https://codesystem.x12.org/005010/1322\",\n                        \"code\": \"I\",\n                        \"display\": \"Initial\"\n                      }\n                    ]\n                  }\n                }\n              ],\n              \"sequence\": 2,\n              \"productOrService\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://www.cms.gov/Medicare/Coding/HCPCSReleaseCodeSets\",\n                    \"code\": \"G0153\"\n                  }\n                ]\n              },\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/1365\",\n                    \"code\": \"3\",\n   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             \"timingPeriod\": {\n                \"start\": \"2021-09-01\",\n                \"end\": \"2021-09-03\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"admissionDates\",\n                    \"display\": \"Admission Dates\"\n                  }\n                ]\n              },\n              \"sequence\": 4,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-10\",\n                \"end\": \"2021-09-12\"\n              }\n            },\n            {\n              \"category\": {\n                \"coding\": [\n                  {\n                    \"system\": \"http://hl7.org/fhir/us/davinci-pas/CodeSystem/PASTempCodes\",\n                    \"code\": \"dischargeDates\",\n                    \"display\": \"Discharge Dates\"\n                  }\n                ]\n              },\n              \"sequence\": 5,\n              \"timingPeriod\": {\n                \"start\": \"2021-09-13\",\n                \"end\": \"2021-09-15\"\n              }\n            }\n          ],\n          \"accident\": {\n            \"date\": \"2016-03-09\",\n            \"type\": {\n              \"coding\": [\n                {\n                  \"system\": \"http://terminology.hl7.org/CodeSystem/ex-claimaccidenttype\",\n                  \"code\": \"auto\",\n                  \"display\": \"Automobile\"\n                }\n              ]\n            }\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/UMOExample\",\n        \"resource\": {\n          \"resourceType\": \"Organization\",\n          \"id\": \"UMOExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-requestor\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"8189991234\"\n            },\n            {\n              \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n              \"value\": \"8189948234\"\n            }\n          ],\n          \"active\": true,\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"X3\"\n                }\n              ]\n            }\n          ],\n          \"name\": \"DR. JOE SMITH CORPORATION\",\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"contact\": [\n            {\n              \"telecom\": [\n                {\n                  \"system\": \"other\",\n                  \"value\": \"http://hl7.org/fhir\"\n                }\n              ],\n              \"name\": {\n                \"family\": \"WATSON\",\n                \"given\": [\n                  \"SUSAN\"\n                ]\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Organization/InsurerExample\",\n        \"resource\": {\n          \"resourceType\": \"Organization\",\n          \"id\": \"InsurerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-insurer\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"789312\"\n            },\n            {\n              \"system\": \"http://terminology.hl7.org/NamingSystem/USEIN\",\n              \"value\": \"7239994834\"\n            }\n          ],\n          \"active\": true,\n          \"type\": [\n            {\n              \"coding\": [\n                {\n                  \"system\": \"https://codesystem.x12.org/005010/98\",\n                  \"code\": \"PR\"\n                }\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"3029993456\"\n            }\n          ],\n          \"name\": \"MARYLAND CAPITAL INSURANCE COMPANY\"\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Coverage/InsuranceExample\",\n        \"resource\": {\n          \"resourceType\": \"Coverage\",\n          \"id\": \"InsuranceExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-coverage\"\n            ]\n          },\n          \"status\": \"active\",\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"1234567cov\"\n            }\n          ],\n          \"beneficiary\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"payor\": [\n            {\n              \"reference\": \"Organization/InsurerExample\"\n            }\n          ],\n          \"subscriber\": {\n            \"reference\": \"Patient/SubscriberExample\"\n          },\n          \"subscriberId\": \"12345678901\",\n          \"relationship\": {\n            \"coding\": [\n              {\n                \"system\": \"http://terminology.hl7.org/CodeSystem/subscriber-relationship\",\n                \"code\": \"self\"\n              },\n              {\n                \"system\": \"https://codesystem.x12.org/005010/1069\",\n                \"code\": \"18\",\n                \"display\": \"Self\"\n              }\n            ]\n          }\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Patient/SubscriberExample\",\n        \"resource\": {\n          \"resourceType\": \"Patient\",\n          \"id\": \"SubscriberExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-subscriber\"\n            ]\n          },\n          \"extension\": [\n            {\n              \"url\": \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/extension-militaryStatus\",\n              \"valueCodeableConcept\": {\n                \"coding\": [\n                  {\n                    \"system\": \"https://codesystem.x12.org/005010/584\",\n                    \"code\": \"RU\"\n                  }\n                ]\n              }\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2106-3\",\n                    \"display\": \"White\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Caucasian\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-race\"\n            },\n            {\n              \"extension\": [\n                {\n                  \"url\": \"ombCategory\",\n                  \"valueCoding\": {\n                    \"system\": \"urn:oid:2.16.840.1.113883.6.238\",\n                    \"code\": \"2135-2\",\n                    \"display\": \"Hispanic or Latino\"\n                  }\n                },\n                {\n                  \"url\": \"text\",\n                  \"valueString\": \"Filipino\"\n                }\n              ],\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-ethnicity\"\n            },\n            {\n              \"url\": \"http://hl7.org/fhir/us/core/StructureDefinition/us-core-birthsex\",\n              \"valueCode\": \"M\"\n            }\n          ],\n          \"identifier\": [\n            {\n              \"system\": \"http://davinci-pas.org/MIN\",\n              \"value\": \"12345678901\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"SMITH\",\n              \"given\": [\n                \"JOE\"\n              ],\n              \"prefix\": [\n                \"Mr\"\n              ],\n              \"suffix\": [\n                \"PharmD\"\n              ]\n            }\n          ],\n          \"gender\": \"male\",\n          \"birthDate\": \"1987-02-20\",\n          \"multipleBirthInteger\": 1,\n          \"communication\": [\n            {\n              \"language\": {\n                \"coding\": [\n                  {\n                    \"system\": \"urn:ietf:bcp:47\",\n                    \"code\": \"nl-NL\",\n                    \"display\": \"Dutch (Netherlands)\"\n                  }\n                ]\n              },\n              \"preferred\": true\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"555-555-5555\",\n              \"use\": \"home\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"49 Meadow St\"\n              ],\n              \"city\": \"Mounds\",\n              \"state\": \"OK\",\n              \"district\": \"Meadow\",\n              \"postalCode\": \"74047\",\n              \"country\": \"US\",\n              \"period\": {\n                \"start\": \"2016-12-06\",\n                \"end\": \"2020-07-22\"\n              }\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/PractitionerRole/ReferralPractitionerRoleExample\",\n        \"resource\": {\n          \"resourceType\": \"PractitionerRole\",\n          \"id\": \"ReferralPractitionerRoleExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitionerrole\"\n            ]\n          },\n          \"practitioner\": {\n            \"reference\": \"Practitioner/ReferralPractitionerExample\"\n          },\n          \"organization\": {\n            \"reference\": \"Organization/UMOExample\"\n          },\n          \"location\": [\n            {\n              \"reference\": \"Location/ReferralLocationExample\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Practitioner/ReferralPractitionerExample\",\n        \"resource\": {\n          \"resourceType\": \"Practitioner\",\n          \"id\": \"ReferralPractitionerExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-practitioner\"\n            ]\n          },\n          \"identifier\": [\n            {\n              \"system\": \"http://hl7.org/fhir/sid/us-npi\",\n              \"value\": \"987654321\"\n            }\n          ],\n          \"name\": [\n            {\n              \"family\": \"WATSON\",\n              \"given\": [\n                \"SUSAN\"\n              ]\n            }\n          ],\n          \"telecom\": [\n            {\n              \"system\": \"phone\",\n              \"value\": \"4029993456\"\n            }\n          ],\n          \"address\": [\n            {\n              \"line\": [\n                \"111 1ST STREET\"\n              ],\n              \"city\": \"SAN DIEGO\",\n              \"state\": \"CA\",\n              \"postalCode\": \"92101\",\n              \"country\": \"US\"\n            }\n          ]\n        }\n      },\n      {\n        \"fullUrl\": \"http://davinci-pas.org/fhir/Location/ReferralLocationExample\",\n        \"resource\": {\n          \"resourceType\": \"Location\",\n          \"id\": \"ReferralLocationExample\",\n          \"meta\": {\n            \"profile\": [\n              \"http://hl7.org/fhir/us/davinci-pas/StructureDefinition/profile-location\"\n            ]\n          },\n          \"name\": \"REFERRAL CLINIC\",\n          \"address\": {\n            \"line\": [\n              \"111 1ST STREET\"\n            ],\n            \"city\": \"SAN DIEGO\",\n            \"state\": \"CA\",\n            \"postalCode\": \"92101\",\n            \"country\": \"US\"\n          }\n        }\n      }\n    ]\n  }\n]"
+    }
+  ]
+}